Overwhelmed College Counseling Services Struggle To Offer All Students Immediate Access To Care

Upper West Side NY

20 October, 2021

1:36 PM

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Columbia Daily Spectator BY BEN DAHAN OCTOBER 20, 2021 Editor's note: Some students interviewed have been provided pseudonyms to protect their privacy. Disclaimer: Although wait times for students with "routine" concerns can be long, CPS is committed to ensuring that those with urgent needs are met with swift and robust care. CPS will always accommodate someone who is in crisis immediately. And for those with less urgent needs, students can discuss their concerns with Alice! Health Promotion specialists who can help them strategize how to manage their issues and point them to other resources they can leverage. Anna was feeling overwhelmed with school, facing abuse from her roommate, and suffering from pre-existing mental health issues. One night, things got so bad at home that she tried to sleep in Butler Library. That's when she sought help from Counseling and Psychological Services during their walk-in hours. But when she tried to schedule an appointment to begin seeing a therapist regularly, she was given the option between an appointment in three weeks or one that opened up the following day due to a last-minute cancellation. Anna skipped class the next day to go. "It could have been life-saving," Anna said. "I don't know what would have happened if I had to wait three weeks." Despite CPS's 36 percent increase in staffing in the past four years to meet rising demand in a historically high-stress campus culture, wait times lasting weeks have remained a barrier for students for years. While CPS prioritizes students in crisis, for those with less urgent concerns, CPS's limited capacity sometimes means that students must wait several weeks for their first appointment, which experts say can exacerbate mental health issues. CPS met student demands during the pandemic by offering telehealth options, but the return to campus presents unique challenges to student wellbeing. As universities nationwide find themselves overwhelmed, many students feel like they might fall between the cracks. "Just because someone's not at immediate risk of harming themselves doesn't mean we can push off their mental health issues further, because things can easily spiral," Chris Mendell Jr., GS '23, said. Columbia is not alone. According to Dr. Emma Seppälä, a mental health researcher at Yale School of Management, universities across the country are facing overburdened campus mental health resources. "Mental health issues on US college campuses [have] been on a steep decline for over a decade—only getting worse during the pandemic," Seppälä wrote in an email to Spectator. "Universities have responded by adding more counseling and psychiatric services—yet they remain overwhelmed." Students who hope to begin individual counseling through CPS must schedule an initial treatment planning session, during which a CPS provider will determine the student's needs, make an appointment with a counselor, and direct them to other resources. CPS has completed over 1,000 of these planning sessions since the start of the semester. In addition to one-on-one counseling, CPS offers over 20 virtual support spaces, drop-in problem-solving sessions, skill-building groups to help students better manage stress and anxiety, and information on coping tools. International students abroad can access care through WorkPlace Options, an independent University partner agency. Students with urgent mental health needs can drop in at Lerner 502 or call 212-854-2878 to access support 24/7. "If a student is in crisis, CPS will ensure that they are connected to care immediately," a Columbia Health spokesperson said. While students may wait for an appointment, CPS counselors provide helpful care and necessary support. "People do care," Anna said. "A lot of CPS therapists, like the ones that I have met, have been very nice, very helpful, but there's only so much they can do." When Mendell first sought help through CPS, he was surprised that his first appointment was a 10-minute intake call rather than an opportunity for counseling. He missed his next appointment with a therapist due to a communication error, and the rescheduled meeting was later canceled because the therapist had an office meeting. By this point, Mendell had already spent three weeks navigating the resource without talking to a counselor. He felt overwhelmed. "If I had been able to talk to a [CPS] psychologist, maybe I could have talked to them, gotten some techniques down and figured this out before it got to the point where I was spiraling," Mendell said. "I think the notion of being able to put off mental health care is wrong. You're not taking mental health seriously in that case." According to Dr. Jerome Schultz, a clinical neuropsychologist at Harvard Medical School, mental health problems tend to get worse the longer it takes for them to be attended to. "The longer those lower-level problems don't get addressed, the greater the likelihood that those lower-level problems will escalate into higher-level problems," Schultz said. "That's the evolution of mental illness, especially if there's nothing to intervene at the lower level." Wait times like those at CPS are not unique to Columbia—they reflect a national pattern at universities. According to the International Accreditation of Counseling Services, students with more "traditional" adjustment and developmental disorders get less assistance when limited resources are prioritized toward students in crisis. Because of such waitlists, students sometimes choose to not seek counseling on campus. According to a survey from the Association for University and College Counseling Center Directors, the national average wait time at college counseling centers, from the first request for services to the first appointment, is four business days, and from triage to the first appointment about seven business days. Although CPS's "staff to student ratio far exceeds the national average and accreditation standards," multiple University undergraduates have reported waiting up to three weeks for their first appointment with a CPS therapist. Columbia can be an especially high-stress environment for students, with academic requirements and social pressures fueling a campus stress culture. In 2017, a series of student suicides led to calls for mental health reforms. "[At Columbia] you have a population of students that tend to overwork, overstress. This is a population that needs therapy, probably more than other ones," Aisha, another student who has tried to access CPS, said. According to the American Psychological Association's annual survey, college-aged Americans are reporting more stress than previous years, due to the isolation of COVID-19. And according to Schultz, who began his career as a developmental psychologist for middle and high school students, students now enter college with fewer coping skills than those in the past. "These kids are bright, capable, talented kids who get accepted to the best colleges in America, and they're bringing that stress with them," Schultz said. "It comes in their suitcase with their new college clothes." According to a 2018 Columbia report on student wellbeing, the University found that 41 percent of respondents had severe stress related to finding employment, almost one-third had frequent trouble sleeping, and one-fifth had trouble concentrating. Additionally, 16 percent demonstrate symptoms consistent with generalized anxiety disorder, and 9 percent have symptoms consistent with a major depressive episode. The Arts and Sciences Graduate Council's 2020 Quality of Life survey found that 46 percent of respondents do not believe the University is addressing the issue of stress among graduate students. This pervasive stress culture can have a negative impact on student performance. According to Schultz, if students do not feel safe or healthy, they will not be able to devote their attention to their studies. Anna had to put off school to get well again, and Mendell lost out on an internship. When students with routine concerns feel they need counseling help sooner than CPS can accommodate them, they can get a referral for off-campus therapy through CPS. However, this option often requires a copay, making it inaccessible to many of the students who need it most. "I almost felt kind of disrespected because they said if you need help sooner, you have to go off campus for $20," Mendell said. "I'm a first-generation, low-income student, so to go off campus for $20 a week … could be the difference between getting dinner one day or not." Many universities and mental health practitioners are thinking of ways to innovate mental health services. In addition to increasing counseling staff, universities are looking to other avenues, such as group counseling and mental health apps. At present, CPS offers virtual support spaces based on student's identity or skill-based groups fostering coping skills. According to Schultz, one-on-one therapy is an untenable, expensive model for universities that fails to meet the mental health needs of all students, leading some counseling centers to seek graduate students with inadequate experience as an intern workforce. Nevertheless, for some students, counseling is a necessary resource, and one they may feel they can not access. "I can help myself a little bit, but sometimes you just can't, you need somebody else," Aisha said. "And if that's not there, what are you really supposed to do?" Some have noted that addressing mental health on college campuses requires going beyond just increasing the capacity of mental health services, but also addressing the pervasive stress culture common to American universities. Adam Johnson, a professor of anthropology at University of Texas San Antonio, began thinking more critically about his students' mental health after his class underwent an active shooting. Since then, he's adopted a new teaching approach to create a collaborative, low-stress environment for his students. Structural factors that lead to student stress and declining mental health, according to Johnson, include high cost of attendance, GPAs, power dynamics in the classroom, and pedagogical design. "I think the first step, and maybe the hardest step [to improve student mental health], is going to be structural changes at the university level, because a lot of the things that contribute to student mental health crises are structural in nature," Johnson said. Students can make an appointment with CPS through their Patient Portal, or by calling 212-854-2878. For 24/7 support, call 212-854-7426. Staff writer Ben Dahan can be contacted at [email protected]. Follow Spectator on Twitter @ColumbiaSpec. Founded in 1877, the Columbia Daily Spectator is the independent undergraduate newspaper of Columbia University, serving thousands of readers in Morningside Heights, West Harlem, and beyond. Read more at columbiaspectator.com and donate here.